Environmental Exposures: Avoid Asthma Triggers

GIP Priority Message: Control Environmental Exposures

Clinicians should review each patient’s exposure to allergens and irritants and provide a multipronged strategy to reduce exposure to those allergens and irritants to which a patient is sensitive and exposed, that is, that make a patient’s asthma worse.

Begin with an environmental assessment

Conducting an initial environmental assessment for patients who have asthma at any level of severity should provide information that the clinician can use to educate patients on actions to take toward reducing exposure to those allergens and irritants that worsen a patient’s asthma.

Conducting a more detailed environmental assessment in the patient’s home (or other settings where a patient spends considerable time, such as school or work) may also be useful for certain patients (for example, those patients whose asthma is not well-controlled or whose asthma is work-related).

For patients who have persistent asthma and are exposed to indoor allergens year round, follow-up steps to an initial environmental assessment may include allergy testing to determine sensitivity to allergens, with results considered in the context of the patient’s overall medical history. Conducting skin or in vitro testing to confirm sensitivity helps to narrow the focus of a patient’s allergen/irritant exposure control strategy to those factors that will have the greatest effect.

Provide education and resources to reduce environmental exposures

A patient’s written asthma action plan should identify individual allergens and irritants that worsen the patient’s asthma. Evidence demonstrates that, for an allergen- and irritant-sensitive person who has asthma, substantially decreasing exposure to inhalant allergens may significantly reduce inflammation, symptoms, and the need for medication. Furthermore, certain respiratory irritants such as tobacco smoke and air pollution are associated with increased symptoms and increased use of healthcare services.

Using multiple approaches to reduce exposure to known allergens and irritants is imperative for effective exposure control, since individual steps are generally ineffective. The NHLBI offers many useful tips for controlling things that make asthma worse (see page 2 of NHLBI’s Asthma Action Plan). Community resources, including in-home support for allergen and irritant reduction, are helpful in controlling environmental factors that can make asthma worse.